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Glycated Hemoglobin and How to Lower It

Updated on December 29, 2016
Dr Pran Rangan profile image

I am a physician by profession. I like to write on topics related to health, psychology, psychiatry, and spirituality.

What Is Glycated Hemoglobin?

Glycated hemoglobin, also called hemoglobin A1c, HbA1c, A1c, or Hb1c, is a form of hemoglobin that is measured primarily to know the average plasma glucose concentration over a three-month period. It is limited to a three month average because the lifespan of a red blood cell is four months. As red blood cells do not all undergo lysis (breaking down of cell membrane) at the same time, HbA1c is taken as a limited measure of 3 months. Normal levels of glucose produce a normal amount of glycated hemoglobin. As the average amount of plasma glucose increases, the fraction of glycated hemoglobin increases in a predictable way.

In diabetes mellitus (or diabetes), higher amounts of glycated hemoglobin indicate poorer control of blood glucose levels. It is tested to monitor the long-term control of diabetes.

For people without diabetes, the normal range for the hemoglobin A1c level is between 4% and 5.6%. Hemoglobin A1c levels between 5.7% and 6.4% mean one has a higher chance of getting diabetes (pre-diabetes). Levels of 6.5% or higher mean one has diabetes. Diabetics who keep their hemoglobin A1c levels close to 7% have a much better chance of delaying or preventing diabetes complications than people with levels 8% or higher.

Lowering the level of hemoglobin A1c by any amount improves a person's chances of staying healthy.

How to Lower Glycated Hemoglobin

The glycated hemoglobin score is a valuable part of diabetes control. In fact, diabetes is a tough condition to manage. It requires real work, but the time and effort you put into it can result in good control and an improved quality of life. The key to reaching your A1C goal is trying to follow a healthy lifestyle, which can help you improve your day-to-day blood sugar management and lower your A1C. These are the best strategies to lower the glycated hemoglobin levels:

Move more - The more physically active one is the more likely one is to have good A1c contro. Any extended sitting such as behind a desk at work or behind the wheel can be harmful for diabetics. The solution seems to be less sitting and more moving overall. The impact of movement even leisurely one can be profound.

Exercise regularly – According to a study published in JAMA, for individuals with type-2 diabetes an exercise schedule should include both aerobic and resistance training in order to improve A1c level. But few studies have directly examined this exercise combination.

Experts recommend 30 minutes of moderate-to-vigorous intensity aerobic exercise at least 5 days a week or a total of 150 minutes per week. The activity should be spread out over at least 3 days during the week with a period of rest of no more than 2 days in a row. They also recommend some type of strength training at least 2 times per week in addition to aerobic activity. But, oddly enough, nine out of 10 fail to meet this guideline.

Eat Healthy – By including plenty of vegetables and fruits in diet one can lower A1c. One should go for low fat lean protein and fish such as salmon, trout, tuna, sardines, mackerel, and herring, which also contain omega-3 fatty acids. In addition, diabetics should control carbohydrates, fatty foods and calories by limiting intake of potatoes, rice, and foods containing white flour. By passing up sugary desserts, candy, ice cream, soft drinks and store-bought cookies, pies, baked goods and doughnuts and avoiding fried chicken, frozen dinners, lunch meats, sugared soft drinks, fruit drinks, milk shakes, hamburgers, pizza and chicken and fish sandwiches, a diabetic can lower one’s A1C levels.

Use of Cinnamon - The experts have found that taking cinnamon could be useful for lowering serum HbA1C in type-2 diabetics. Cinnamon is purported to be a natural insulin sensitizer. But randomized trials studying cinnamon in humans with type-2 diabetes have shown conflicting results.

Lose Weight – It has been found by experts that intentional weight loss of 10% can potentially decrease A1c by 0.81% among overweight and obese patients with type-2 Diabetes Mellitus. So, this can serve as an encouragement for persons attempting weight loss. One should strive to achieve one’s healthy weight and try best to stay at it. Though some people have normal weight, they still sport a potbelly. This is bad for A1c level as it makes difficult for one to achieve a normal level. So, if one has to fight the battle of bulge, one should do so fiercely.

Quit Smoking - Among other harmful effects, smoking increases abdominal fat accumulation and insulin resistance. It is a well-established risk factor for diabetes and its complications. Therefore, smokers should be encouraged to quit smoking because it makes difficult for them to manage their A1c levels.

Get Adequate Sleep - Short or long sleep durations are associated with higher A1C levels. Researchers have found that the average A1c level for people, who sleep between 6.5 to 7.4 hours per night, is the lowest at 7.3 percent, while those, who sleep less than 4.5 hours and more than 8.5 hours, has average A1Cs of 7.6 percent and 7.4 percent respectively.

Learn to Manage Stress – It has been found that chronic stress in type-1 and type-2 diabetes is strongly associated with A1c particularly in people, who face disproportionate stress because of lack of family or social support. So, with proper stress management intervention techniques, people with diabetes show improvements in A1c levels.

Take medications regularly – Besides lifestyle modifications, medications as prescribed by experts, if taken regularly, can help maintain A1c level within normal range. Insulin therapy makes a real difference for millions of people with type-1 and type-2 diabetes, so do oral hypoglycemic agents (OHA) and some other drugs in type-2 diabetes. A new drug, called dapaglifozin, can prevent glucose re-absorption into the kidneys, lowering A1c and reducing insulin doses in type-2 diabetes. New drugs called non-insulin injectables are available for people with type 2 diabetes.

Always make sure that you take medications as advised by an expert in the management of diabetes. Never self-medicate.

Final Thoughts

According to the International Diabetes Federation, the total number of people with diabetes is projected to rise from 415 million in 2015 to 642 million in 2040 worldwide. Moreover, 5 million deaths have occurred in 2015. Another way of thinking about these numbers is that every 6 seconds, 1 person dies from this condition. These statistics show how important it is for people to manage their diabetes. In this context, the A1c level is a key indicator as to how a person is able to manage one’s diabetes.

There is ample evidence that lifestyle changes affect glycated hemoglobin levels. Thus, by adopting the positive lifestyle modifications listed above, diabetics will be able to lower their A1c levels to a healthy range.

References

Diabetes Educ., "Association between glycosylated hemoglobin and intentional weight loss in overweight and obese patients with type 2 diabetes mellitus: a retrospective cohort study," May-June 2012, 38(3):417-26.

IDF Diabetes Atlas Seventh Edition 2015

The JAMA Network, "Effects of Aerobic and Resistance Training on Hemoglobin A1c Levels in Patients With Type 2 Diabetes: A Randomized Controlled Trial," Nov. 24, 2010.

Sleep Med., "Association between sleep duration and hemoglobin A1c level," Oct. 2008, 9(7):745-52. Epub 2007 Oct 24.

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